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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License Lic. Class Exp. Date
13 `I
L.P
ate �� Signature of Contractor -� -�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). '
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
K
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following' declarations:
( ) I have and will maintain a certificate of�consent to self -insure for workers'
compensation, as -provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for .the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
XfA'1'F E{�f1+713 1440931-98
(This section need not be completed if the permit valuation is for $100.00 or less).
. ( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation- rovisions of Sectio 3700 of, the Labor
Cdde, I h I fo . with comply with t - o e provisions.
✓Date: �� Applicants_ /� �,A
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject'to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null,and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of thisCity to enter upon
the above-mentioned property(for inspection pur oses4
/"•. y
Signature (Owner/Agent) a?iLP.t� gz ate
y
BUILDING PERMIT PERMIT#
DATE �s VALUATION LOT 9".5-103 TRACT
JOB SITEAP
N
ADDRESS 79-7%
9-/R1RC:�1M'% CtRRo, LE,
:R/
604-040-02.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
YNCO HOMES CORP.
[NCO .HOMES CORP.
1282 W. ARR01AV HWY
1.282 V.AR.ROW 14INY
UPLAND CA 91785
UPLAND CA 91785
(409)981-13959 CAL# 33.18
USE OF PERMIT
P 444 DO Y Tm
-00,
.SF.D -PLAN 3A-'3, 'LO i 11. = PEW. T DOES NOT INCLUDE BLOCK
'WALLS OR POOL.
`
TRACT0,INSTRI.TC HON 116%.00 SE'
PORCHuPATIO 94.00 SF
GAR.A.Crt3JCARPORT 593.00 SF
LeST D.A'IA".CE D COs ' OF CONSTRUCTION
104,769.80
PER.WY FEE SUMMARY
CONS`!"RUCTI014.F'FE 10.1-000-418-000 $657.00
PLAN CHECK FEE 101-000-439-318 X553.26
MECHANICAL FEE 101-000-421-000 At4G,3i/
J LEC"I'RICA"L. FEE 101-000420-000 $119.52
P'.LUN03ING Fi.'R 101-000419-000 $148.00
ST:t2.C,3NG MC7'lION FiEE, - RES[D 101-000-241-000 SWAS
GRA1XNG .FM 101-000-423.000 VX1.40
1NF kS`rRUC'[ URF ML 225=000-443-342 • $2^ 329,1.9
ART 114 PUBLIC PLACES -12&S1i; 70"00-2-55-000 S 1.1.9y
s rE-Torr- L CaNs,mtlCnbN AND PLAN CHECK
`� LESS PR -1'.t ID :FEES
$0.00
r TOTAL IPERART f'EE.S I.DITF NOM,
S3,914.87
19p�9 e
,
RECEIPTTE
(PV1
BY J� "i f
DATA 0
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Tootings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
—z 7 — ofj-
F.A.U.
Framing
-Z3 -- G
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final — o-
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRTCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final—
Utility Notice (Perm)
COMMENTS: